Presentation
Low-grade fever with subacute behavioral changes and somnolence 8 days ago.
Patient Data
T2 shows high signals in the right temporal lobe including the amygdala, hippocampus, parahippocampal gyrus, and insular cortex with less intense restricted diffusion of these lesions.
MRA looks normal.
Case Discussion
The patient went on to have a lumbar puncture. CSF analysis:
CSF protein = 70mg/dl (Normal <60)
CSF cell count: 1000 cells/microL.
Lymphocytes: 85%
Polymorphs: 15%
The above-described radiological findings are impressive for herpetic encephalitis.
Immediate treatment with antiviral drugs (acyclovir) is recommended without delay with these typical radiological findings and CSF results in the right clinical settings.
The patient became fully conscious after 14 days and was discharged to home.
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